This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Neurologic damage following cardiac surgery continues to be an important cause of postoperative morbidity and loss of social functioning. Recent evidence has shown patients with diabetes are at risk for larger and more numerous brain infarctions following cardiac surgery and thus research into classification, management and outcome in patients with diabetes is important. At the present time about one third of patients having Cardiac Surgery have a history of diabetes, whereas 50-70% require insulin in the operating room to control blood sugar. This research proposal will outline a comprehensive program for demonstration of genotype, phenotype and outcome in a group of patients undergoing cardiac surgery. We will undertake study of 564 patients over five years which will demonstrate current risk of poor outcome under optimum management strategies. With optimal management we would anticipate significant improvement in Neurologic, Neurobehavioral and Overall outcome coupled with fewer MRI brain infarctions at one week. This clinical study will take the form of a pilot program which could grow into a much larger and more comprehensive multi-institutional research program.